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Maryland PRAMS Report

Maryland Department of Health and Mental HygieneCenter for Maternal and Child Health Vital Statistics Administration

PRAMSPRAMSPRAMSPregnancy Risk Assessment Monitoring System

Robert L. Ehrlich, Jr., Governor; Michael S. Steele, Lieutenant Governor; Nelson J. Sabatini, Secretary

2001 BirthsC

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“I just wanted to say that I hope my answers will help mothers and babies in the future be healthier” PRAMS mother

Maryland PRAMSReport

2001 Births

Family Health AdministrationCenter for Maternal and Child Health

Bonnie Birkel, C.R.N.P., M.P.H., DirectorMaureen Edwards, M.D., M.P.H., Medical Director

Vital Statistics AdministrationIsabelle Horon, Dr.P.H., Director

Diana Cheng, M.D., PRAMS Project DirectorHelen Espitallier, M.S., PRAMS Project Coordinator

Rosemary CarverAndrew Hannon, L.C.S.W.-C.

Robert Hayman, Ph.D.Isabelle Horon, Dr.P.H.Laurie Kettinger, M.S.

Debbie KromeJodi Shaefer, R.N., Ph.D.

Marnita SimonHal Sommers, M.A.

andSchaefer Center for Public Policy,

University of Baltimore

March 2004

The Maryland PRAMS Reportis also available at

www.fha.state.md.us/mch/html/prams_fs.html

For further information,please contact:

Diana Cheng, M.D.PRAMS Project Director

Medical Director, Women’s HealthCenter for Maternal and Child Health

Maryland Department of Health and Mental Hygiene201 W. Preston Street, Room 317

Baltimore, Maryland 21201Phone: 410-767-6713

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sampling and Data CollectionWeighting ProceduresData Analysis

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maryland PRAMS Steering Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maryland PRAMS Highlights 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Maryland PRAMS 2001 Surveillance and Selected Healthy People 2010 Objectives . . . . . . . . . . . .

Preconception Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersIntendedness of PregnancyContraceptive Use Among Mothers with an Unintended PregnancyReasons for Not Using Birth Control Among Mothers With an Unintended PregnancyMultivitamin Use in Month Before PregnancyUse of Fertility DrugsUse of Assisted Reproductive Technology

Prenatal Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersTrimester of Pregnancy ConfirmationTrimester Prenatal Care BeganSatisfaction with Time of Initiation of Prenatal CareReasons for Late Prenatal CareTopics Discussed During Prenatal Care VisitsStress during the 12 Months Before DeliveryComplications During PregnancyHospital Admissions and Bedrest During Pregnancy Due to ComplicationsRecommendation of One or More Weeks of Bedrest During PregnancyDental Care During Pregnancy

Health Care Coverage and WIC Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersHealth Insurance Just Before PregnancyMedicaid Coverage Just Before PregnancySource of Payment for Prenatal CareWIC Participation during PregnancySource of Payment for Delivery

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TABLE OF CONTENTS

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Selected Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersAsked About Smoking During Prenatal CareSmoking During the Three Months Before PregnancySmoking During the Last Three Months of PregnancySmoking After PregnancyAsked About Alcohol Use During Prenatal CareAlcohol Use During the Three Months Before PregnancyAlcohol Use During the Last Three Months of PregnancyAlcohol Binges During the Three Months Before PregnancyAlcohol Binges During the Last Three Months of PregnancyPhysical Abuse by Husband or Partner During the 12 Months Before PregnancyPhysical Abuse by Non-Partner During the 12 Months Before PregnancyPhysical Abuse by Husband or Partner During PregnancyPhysical Abuse by Non-Partner During PregnancySeat Belt Use by Mother During PregnancySeat Belt Use by Mother Postpartum

Postpartum Factors: Maternal and Infant Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersUse of Birth ControlReasons for Not Using Postpartum Birth ControlPostpartum DepressionNeonatal Intensive Care Unit AdmissionLength of Hospital Stay for NewbornBreastfeeding InitiationBreastfeeding Length of TimeInfant Sleep PositionInfant Health Care Visit in the First Week After Leaving Hospital

Maryland PRAMS Phase 4 Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Comments from PRAMS MothersSurvey

3334353637383940414243444546474849

5152535455565758596061

636465

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INTRODUCTION

This report highlights 2001 data collected in Maryland through the Pregnancy Risk AssessmentMonitoring System (PRAMS). PRAMS is a surveillance system established by the Centers for DiseaseControl and Prevention (CDC) in 1987 to obtain information about maternal behaviors and experiences thatmay be associated with adverse pregnancy outcomes. Data are collected by surveying women who haverecently delivered live born infants.

PRAMS projects are conducted through cooperative agreements between the CDC and state healthdepartments. PRAMS projects are currently underway in 31 states and New York City. All surveys includea core set of standardized questions, which allows for multi-state analyses. In addition, each state can addquestions tailored to meet its needs. The core section of the survey includes questions relating to prenatalcare, obstetric history, smoking, alcohol use, physical abuse, contraception, economic status, maternalstress, and infant health. The Maryland-specific section of the survey includes questions on assistedreproduction, contraceptive use, depression, oral health, bedrest during pregnancy, social services, andseatbelt use.

The PRAMS project in Maryland is a collaborative effort of the Center for Maternal and ChildHealth (CMCH), the Vital Statistics Administration (VSA) of the Maryland Department of Health andMental Hygiene, and the CDC. Maryland began collecting PRAMS data from mothers who deliveredin 2000.

METHODOLOGY

Sampling and Data Collection

Women eligible to participate in PRAMS are selected from Maryland’s live birth certificate files.Each month, a stratified, random sample of approximately 200 live births is selected. The sample isstratified by maternal age (<20 years, 20-34 years, >35 years) and infant birth weight (<2500 grams,>2500 grams). This sampling frame over-samples mothers who have delivered a low birth weight infant(<2500 grams) as well as mothers who are under 20 years of age or 35 years of age or older.

PRAMS combines two modes of data collection, a survey conducted by mailed questionnaire withmultiple follow-up attempts, and if mail is not successful, a survey conducted by telephone interview.Survey questionnaires and other materials are available in both English and Spanish.

The first mailing, which is done two to four months after delivery, is a letter that introduces PRAMSto the mother and informs her that a questionnaire will soon arrive. Within seven days of this letter, thequestionnaire packet is mailed. This packet includes the 86-item survey, PRAMS brochure, calendar andresource brochure. In addition, a telephone card is sent as an incentive for completing the survey. Seven to10 days after the initial packet is mailed, a tickler that serves as a thank you and reminder note is sent.Mothers who do not respond to the tickler within seven to 14 days are mailed a second questionnairepacket. A third questionnaire packet is mailed to all remaining nonrespondents seven to 14 days later.Telephone follow-up is initiated for all nonrespondents.

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Weighting Procedures

Data collected through PRAMS are linked to birth certificate data, which allows for the survey datato be weighted to reflect the total birth population. Sampling, nonresponse and noncoverage adjustmentfactors are applied to the data in order to make the results generalizable to the state’s population of womendelivering live born infants during the study period. Further information on PRAMS methodology, includ-ing weighting procedures, may be found on the CDC website at http://www.cdc.gov/reproductivehealth/methodology.htm.

Data Analysis

CDC recommends that states obtain a response rate of at least 70% for analysis of PRAMS data.The response rate among women delivering in Maryland between January 30, 2001 and December 31, 2001met this criterion, but the response rate in for women delivering before January 30 did not. Therefore,the data presented in this report are based on the last 11 months of 2001, not the entire year. During thisperiod, 1,447 mothers completed the PRAMS questionnaire with a weighted response reflecting 58,982mothers. The weighted figure included 38,834 births to white women and 16,333 births to black women.

All data in this report were prepared using weighted PRAMS data and SUDAAN software.Percentages shown for each survey item are based on the number of mothers who responded to thatitem, with missing observations excluded. With the exception of questions relating to smoking (Questions39-41), alcohol binges before pregnancy (Question 43b) and duration of breastfeeding (Question 61), thepercentage of missing observations was less than 5% for each survey item. Percentages for subcategoriesof survey items based on fewer than five respondents are not reported since estimates based on smallnumbers may be unreliable.

ACKNOWLEDGMENTS

The Maryland PRAMS Project would like to acknowledge the CDC PRAMS Team for their technicalassistance and support, especially Nedra Whitehead, Ph.D. and Denise D’Angelo, M.P.H. our former andpresent project managers, who have expertly guided and assisted our program.

Additionally, our thanks go to the Maryland PRAMS Steering Committee for their invaluable inputto many aspects of our project.

Most importantly, we very much appreciate all the 1,447 mothers who took the time to completethe questionnaires that are represented in this report. Their answers will contribute greatly towards ourcontinuing efforts to improve the health of Maryland mothers and babies.

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MARYLAND PRAMS STEERING COMMITTEE

Meena Abraham, MPHMedChi, Maryland State Medical Society

Carla Bailey, RN, PhDMaryland Institute for Emergency Medical ServicesSystems

Bonnie S. Birkel, CRNP, MPHCenter for Maternal and Child HealthDHMH*

Mary Dallavalle, RD, LD, MSOffice of Maryland WIC ProgramDHMH*

Maureen Edwards, MD, MPHCenter for Maternal and Child HealthDHMH*

Lisa Firth, MBDivision of Maternal and Child HealthBaltimore City Health Department

Jill KuhnProgram ServicesMarch of Dimes, Maryland Chapter

Michelle Lane, RN, BSN, CCRNInfant Mortality Prevention Program & MarylandChildren’s Trust FundGovernor’s Office for Children, Youth and Families

Jade LeungCenter for Health Promotion, Education and TobaccoUse PreventionDHMH*

Ray Miller, MA, LCADCAlcohol and Drug Abuse AdministrationDHMH*

Rosemary Murphey, MBA, RNOffice of Health ServicesDHMH*

Patricia O’Campo, PhDPopulation & Family Health SciencesJohns Hopkins UniversityBloomberg School of Public Health

Nadine Smith, RNDivision of Outreach and Care CoordinationHealth Choice: Acute Care AdministrationDHMH*

Liza Solomon, DrPHAIDS AdministrationDHMH*

Donna Strobino, PhDPopulation & Family Health SciencesJohns Hopkins UniversityBloomberg School of Public Health

*Maryland Department of Health and Mental Hygiene (DHMH)

PRAMS Staff:Diana Cheng, MD, PRAMS Project Director, Center for Maternal and Child Health (CMCH)Helen Espitallier, MS, PRAMS Project Coordinator, CMCHAndrew Hannon, LCSW-C, CMCHIsabelle Horon, DrPH, Vital Statistics AdministrationLaurie Kettinger, MS, CMCHJodi Shaefer, RN, PhD, CMCH

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MARYLAND PRAMS HIGHLIGHTS—2001

Preconception factors

• Forty-two percent of all pregnancies wereunintended. The most frequently cited reasongiven by mothers with unintended preg-nancies for not using contraception was thatthey didn’t mind becoming pregnant.

• Seventy-six percent of women reported havinghealth insurance just before pregnancy, and9% reported they were covered by Medicaid orHealth Choice.

• Approximately 31% of women reported takinga daily multivitamin in the month beforeconception.

• Of mothers trying to get pregnant, 8% reportedusing fertility drugs and 4% used assistedreproductive technology.

Prenatal factors

• Seventy-eight percent of mothers began prena-tal care during the first trimester of pregnancy,and fewer than 1% received no care. Theprimary reasons given for not receiving earlyprenatal care were difficulty in obtaining anappointment, and lack of awareness of thepregnancy.

• Seventy-three percent of women reported thathealth insurance or an HMO paid for theirprenatal care; 23% reported that Medicaid orHealthChoice paid for their care.

• Thirty-three percent of women participated inthe WIC program during pregnancy.

• Sixty-four percent of mothers reported one ormore medical complications during preg-nancy, and 20% of these women were hospital-ized for one or more days.

• Nine percent of women smoked during the lastthree months of pregnancy, and 8% reportedusing alcohol. Fewer than 1% of womenreported a binge-drinking episode during thelast three months of pregnancy.

• Four percent of mothers reported beingphysically abused by a husband or partnerduring pregnancy, and 2% reported beingabused by someone else.

• Forty-six percent of mothers had a routinedental visit during pregnancy, and 26%needed to be seen for a dental problem.

• Fifteen percent of mothers did not alwaysuse a seatbelt during pregnancy.

Infant health and related factors

• Thirteen percent of newborns were admittedto a neonatal intensive care unit.

• Fifty-nine percent of newborns weredischarged from the hospital within twodays of delivery, and 8% remained in thehospital for 6 or more days.

• Seventy-six percent of infants werebreastfed after delivery, and 64% werebreastfed four weeks or longer.

• In terms of sleeping position, 61% of infantswere usually placed on their backs to sleep,and 17% on their stomachs.

• Eighty-four percent of infants were seen by ahealth care provider within a week of beingdischarged from the hospital.

Maternal postpartum factors

• Seventeen percent of mothers reported theywere not using postpartum contraception.The most frequently cited reason for notusing contra-ception was that they werenot having sex.

• Twenty percent of women reported beingat least moderately depressed in the post-partum period.

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MARYLAND PRAMS 2001 SURVEILLANCEAND SELECTED HEALTHY PEOPLE 2010 OBJECTIVES

Preconception Factors

Increase the proportion of pregnancies that are intended.

Increase the proportion of pregnancies begun with theconsumption of at least 400 ug of folic acid each day fromfortified foods or dietary supplements by nonpregnantwomen aged 15-44 years.

Prenatal Health

Increase the proportion of all pregnant womenwho receive prenatal care in the first trimester ofpregnancy.

Reduce cigarette smoking among pregnant women.

Increase abstinence from alcohol by pregnant women.

Increase abstinence from binge drinking by pregnantwomen.

Postpartum Maternal and Infant Health

Increase the percentage of healthy full-term infants whoare put down to sleep on their backs.

Increase the proportion of mothers who breastfeed theirbabies in the early postpartum period.

Healthy People2010 Target

MarylandPRAMS

2001 Births

Healthy People2010 Objective

70%

80%

90%

2%

94%

100%

70%

75%

57.9%*

31.2%

78.1%**

9.4%

91.9%

99.1%

61%

76.5%

* PRAMS data includes only information on pregnancies that end in live birth** First trimester defined by PRAMS as < 13 weeks

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Preconception FactorsC

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“I think talking with the doctor before getting pregnanthelped a lot.”

“An important focus on pregnancy should not only bethe health of the mother before deciding to get pregnant,but also the father.”

“... I wish I had been in better shape before becomingpregnant.”

PRAMS mothers

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INTENDEDNESS OF PREGNANCYQuestion 12: Thinking back to just before you got pregnant, how did you feel about

becoming pregnant?

Distribution of Mothers by Intendedness of Pregnancy

33.7

64.0

34.8

45.0 41.7

76.8

56.0

36.5 36.0

25.5 25.9

39.9

50.2

31.0

0102030405060708090

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Wanted to be pregnant later

31.2%

Didn't want to be pregnant then or

later10.9%

Wanted to be pregnant then

41.5%

Wanted to be pregnant sooner

16.4%

Percentage of Mothers With Unintended Pregnancies

Age Years of education*

*Includes only mothers ages 20 and above.

Unintendedpregnancies

42.1%Intended

pregnancies57.9%

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CONTRACEPTIVE USE AMONG MOTHERS WITH AN UNINTENDED PREGNANCY

Question 14: When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant?

Distribution of Mothers With An Unintended Pregnancy by Use of Birth Control at the Time of Pregnancy

43.248.9

27.3

49.944.1

47.042.5

46.6 47.9

37.540.2

47.3

36.0

51.1

0

10

20

30

40

50

60

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

D id no t use birth co ntro l55.1%

Used birth co ntro l 44.9%

Percentage of Mothers With an Unintended Pregnancy Who Reported Use of Birth Control at Time of Pregnancy



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REASONS FOR NOT USING BIRTH CONTROLQuestion 15: What were your or your husband’s or partner’s reasons for not doing anything to keep

from getting pregnant?

Reasons Given for Not Using Birth Control by Mothers Who Were Not Trying to Become Pregnant

5.0

8.4

15.5

20.0

24.7

33.7

0 10 20 30 40

Mother thought she or partnerwas sterile

Problems getting birth control

Side effects from using birthcontrol

Husband or partner didn't want touse birth control

Mother believed she could not getpregnant at that time

Mother didn't mind becomingpregnant

Percent

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MULTIVITAMIN USEQuestion 3: In the month before you got pregnant with your new baby, how many times a week did

you take a multivitamin (a pill that contains many different vitamins and minerals)?

Distribution of Mothers by Frequency of Multivitamin Use in the Month Before Pregnancy

65.1

78.7

62.6

93

66.6

88.383.6

67.259.2 58.4

69.3

81.675.1

59.2

0102030405060708090

100

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

1-3 times/week9.9%

4-6 times/week5.5%

Every day31.2%

Didn't take53.4%

Percentage of Mothers Who Reported Less Than Daily Multivitamin Use in the Month Before Pregnancy



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“I think that women need to know that while they arepregnant and seeing a doctor, they need to ask all thequestions they want to know, even if they sound silly.”

“I went to a private practice and I believe the doctor neverasked enough questions or spent enough time with me.”

“The midwives talked to me about everything I neededto know, either at the office or by phone call. I neededreassurance on occasion and they gave it convincingly.”

PRAMS mothers

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TRIMESTER OF PREGNANCY CONFIRMATIONQuestion 18. How many weeks or months pregnant were you when you were sure you were pregnant?

Distribution of Mothers by Time at Which Pregnancy Was Confirmed

6.2

22.825.5

9.2

20.2

11.910.2

8.66.9

19.8

15.0

4.5

0

5

10

15

20

25

30

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Second trimester10.1%

Third trimester0.4%

First trimester89.5%

Percentage of Mothers Who Reported Confirming Pregnancy After the First Trimester


*Includes only mothers ages 20 and above.Note: Percentages are not reported if the number of respondents was less than five.

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TRIMESTER PRENATAL CARE BEGANQuestion 19. How many weeks or months pregnant were you when you had your first visit for prenatal

care?

Distribution of Mothers by Trimester Prenatal Care Began

17.9

34.6

10.4

50.1

19.6

48.2

27.1

20.914.9 14.0

23.2

40.1

29.2

9.7

0

10

20

30

40

50

60

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Second trimester20.1%

Third trimester0.9%

No prenatal care0.9%

First trimester78.1%

Percentage of Mothers Who Did Not Begin Prenatal Care During the First Trimester of Pregnancy



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PRENATAL CARE AS EARLY AS DESIREDQuestion 20: Did you get prenatal care as early in your pregnancy as you wanted?

Distribution of Mothers Who Did Not Begin Prenatal Care in the First Trimester by Satisfaction With Time

During Pregnancy That Prenatal Care Began

40.9

59.1

21.5

56.860.8

47.6 46.1 45.452.2

38.7

46.853.6

0

10

20

30

40

50

60

70

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Did Not Begin Prenatal Care in the First Trimester and Reported that Prenatal Care

Did Not Begin Early Enough in Pregnancy


D id no t begin early eno ugh

50.3%

D id no t want care3.0%

B egan early eno ugh46.7%


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REASONS FOR LATE PRENATAL CAREQuestion 21: Did any of these things keep you from getting prenatal care as early as you wanted?

(check all that apply)

Reasons Given for Not Beginning Prenatal Care As Early in Pregnancy As Desired

2.5

6.6

8.5

11.6

13.8

24.1

35.0

36.3

0 10 20 30 40

No child care

No transportation

Didn't have Medicaid card

Too busy

Doctor/health plan would not start careearlier

Didn't have insurance or enough money

Not aware of pregnancy

Couldn't get earlier appointment

Percent

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TOPICS DISCUSSED DURING PRENATAL CARE VISITS

Question 24: During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading

materials or videos.

Percentage of Mothers Reporting That Selected Topics Were Discussed During Prenatal Care Visits

38.2

47.5

58.8

67.3

67.9

76.2

76.7

82.3

84.6

85.1

90.9

0 20 40 60 80 100

Physical abuse

Seat belt use

Effects of illegal drugs during pregnancy

Effects of smoking during pregnancy

Effects of drinking during pregnancy

Postpartum birth control

Breastfeeding

HIV testing

Screening for birth defects or diseases

Medicines that are safe during pregnancy

Early labor

Percent

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STRESSQuestion 45: This question is about things that may have happened during the 12 months before

your new baby was born. For each item, circle yes if it happened to you or no if it did not.

Percentage of Mothers Reporting Stress by Type of Event

4.0

4.2

5.3

10.3

10.9

10.9

11.3

13.1

19.0

20.8

25.2

28.2

32.7

0 10 20 30 40

Mother or partner went to jail

In physical fight

Homeless

Separation/divorce

Husband/partner didn't want pregnancy

Husband/partner lost job

Mother lost job

Someone close had alcohol/drug problem

Someone close died

Couldn't pay bills

Family member hospitalized

Argued with partner more than usual

Moved to a new address

Percent

None26.5%

One or more73.5%

Distribution of mothers by number of stressors

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COMPLICATIONS DURING PREGNANCYQuestion 30: Did you have any of these problems during your pregnancy?

Percentage of Mothers Reporting Pregnancy Complications by Type of Complication

3.0

4.7

5.3

7.7

7.8

12.1

16.3

17.3

24.8

27.2

0 5 10 15 20 25 30

Incompetent cervix

Automobile accident

Premature rupture of membranes

Problems with the placenta

Diabetes

Kidney or bladder infection

Vaginal bleeding

High blood pressure or edema

Severe nausea, vomiting or dehydration

Preterm labor

Percent

None35.9%

One or more64.1%

Distribution of mothers by number of complications

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HOSPITAL ADMISSIONS AND BEDRESTQuestion 31: Did you do any of the following things because of these problem(s)?

(Note: Refers to problems listed in Question 30)

Percentage of Mothers With Problems During Pregnancy Who Had Hospital Admissions or Were Advised Bedrest.

15.8

30.6

5.8

24.7

19.322.3

11.3

22.3 22.9

15.9

25.8

13.8

24.0

17.6

0

5

10

15

20

25

30

35

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers With Problems During Pregnancy Who Spent One or More Days in the Hospital



41.7

15.5

4.1

36.5

05

1015202530354045

Hospital <1 day Hospital 1-7 days Hospital >7 days Bedrest at home >2days

Perc

ent

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BEDREST DURING PREGNANCYQuestion 32: At any time during your most recent pregnancy, were you told to stay in bed for at

least one week?

Distribution of Mothers by Report of Having Been Told to Stay in Bed for One or More Weeks During Pregnancy.

31.3

48.4

37.7

31.236.8 39.1

34.9 35.839.5

31.3

42.137.0 38.0

35.3

0

10

20

30

40

50

60

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Bedrest36.5%

No bedrest 63.5%

Percentage of Mothers Who Reported Having Been Told to Stay in Bed for One or More Weeks During Pregnancy



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DENTAL CARE DURING PREGNANCYQuestion 82: This question is about the care of your teeth during your most recent pregnancy.

(Indicate all that apply)

Distribution of Mothers by Dental Care During Pregnancy

46.9

66.170.3

50.354.0

63.169.2

47.351.1

44.6 43.4

52.259.7

46.8

0

1020

30

40

5060

70

80

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Did Not Report Going to a Dentist or Dental Clinic During Pregnancy



46.9 46.4

26.3

05

101520253035404550

Dental or other health careworker told me how to

care for my teeth and gums

Went to dentist or dentalclinic

Needed to see dentist for aproblem

Perc

ent

24

Health Care Coverageand WIC Participation

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PRAMS Divider3 [Converted].pdf 4/16/04 4:10:36 PMPRAMS Divider3 [Converted].pdf 4/16/04 4:10:36 PM

“WIC was a great help to me throughout my pregnancyand now.”

“... I would encourage Maryland to pursue legislationthat would extend leave for mothers -- both paid andunpaid leave. . . “

“I want to get my tubes tied but have no insurance.”

PRAMS mothers

2 6

HEALTH INSURANCE BEFORE PREGNANCYQuestion 1: Just before you got pregnant, did you have health insurance?

(Do not count Medicaid [including HealthChoice]).

Distribution of Mothers by Health Insurance StatusJust Before Pregnancy

21.329.0 30.3

80.2

18.9

36.4 39.0

24.917.2

10.5 13.1

47.3

37.4

9.6

0102030405060708090

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

No insurance24.0%

Insurance76.0%

Percentage of Mothers Who Reported Having No Health Insurance Just Before Pregnancy



27

MEDICAID BEFORE PREGNANCYQuestion 2: Just before you got pregnant, were you on Medicaid (including HealthChoice)?

Distribution of Mothers by Medicaid CoverageJust Before Pregnancy

4.3

17.5 18.4

9.5 8.7

23.5

14.6

6.65.1 4.4

24.7

9.6

2.5

0

5

10

15

20

25

30

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Medicaid coverage

8.9%

No Medicaid coverage

91.1%

Percentage of Mothers Who Reported Having Medicaid Coverage Just Before Pregnancy



28

SOURCE OF PAYMENT FOR PRENATAL CAREQuestion 23: How was your prenatal care paid for? Check all that apply.

Source(s) of Payment for Prenatal Care* 77

.9

63.1

58.4

25.3

77.0

49.4 54

.5

68.5

85.9 88.8

83.3

45.9

62.5

87.6

16.7

38.9

25.7

52.1

20.6

51.4

42.9

23.3

11.0

8.1

7.7

49.8

32.1

8.3

0

20

40

60

80

100

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Insurance or HMO Medicaid or Health Choice

72.6

23.414.9

3.20

1020304050607080

Healthinsurance/HMO

Medicaid/HealthChoice

Personal income Other

Perc

ent

Percentage of Mothers Who Identified Insurance/HMO or Medicaid/Health Choice as a Source of Payment for Prenatal Care



*Respondents were instructed to identify all sources of payment, therefore percentages do not sum to 100.

29

WIC PARTICIPATIONQuestion 29: During your pregnancy, were you on WIC (the Special Supplemental Nutrition

Program for Women, Infants and Children)?

Distribution of Mothers by Participation in the WIC Program During Pregnancy

24.9

55.9

21.7

79.0

29.2

77.4

55.6

28.9

19.613.9 14.2

62.6

46.0

13.1

0102030405060708090

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Participated33.4%

Did not participate

66.6%

Percentage of Mothers Who Participated in the WIC Program During Pregnancy



30

SOURCE OF PAYMENT FOR DELIVERYQuestion 54: How was your delivery paid for? Check all that apply.

Source(s) of Payment for Delivery* 77

.3

62.8 68

.6

22.6

77.4

49.2 53

.3

71.9

84.4 89

.5

84.7

41.8

63.5

88.2

20.5

39.7

26.0

76.0

21.5

56.1

42.6

26.8

14.6

9.7 11

.1

57.6

35.3

9.8

0102030405060708090

100

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Insurance or HMO Medicaid or Health Choice

72.8

26.2

11.22.6

01020304050607080

Healthinsurance/HMO

Medicaid/HealthChoice

Personal income Other

Perc

ent

Percentage of Mothers Who Identified Insurance/HMO or Medicaid/Health Choice as a Source of Payment for Delivery



*Respondents were instructed to identify all sources of payment, therefore percentages do not sum to 100.

31

Selected Risk Factors

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“Keep stressing the importance of seat belts and properlyused infant car seats for children. I see too many parentsdriving without using them and I worry for thosehelpless children.”

“Creo que toda mujer antes, durante y despues delembarazo debe cuidar mucho su salud. No fumar, no usarbebidas alcoholicas, ni ningun tipo de drogas porque asi sepuede prevenir problemas durante el embarazo.”

(I think all women before, during, and after pregnancyshould really take care of their health. Don’t smoke,don’t drink, don’t do any type of drugs because that ishow you can prevent problems during the pregnancy.)

“I was smoking but once I found out (I was pregnant)ºI stopped.”

PRAMS mothers

3 4

SMOKING AND PRENATAL CAREQuestion 26: At any time during your prenatal care, did a doctor, nurse, or other health care

worker ask if you were smoking cigarettes?

Distribution of Mothers By Report of Having Been Asked About Smoking During Prenatal Care

13.915.8 15.5

5.1

15.4

8.211.1

16.1 14.519

22.3

11.4

23.8

41.5

05

1015202530354045

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Were Not Asked About Smoking During Prenatal Care



Not asked14.5%

Asked85.5%

35

SMOKING BEFORE PREGNANCYQuestion 39: In the three months before you got pregnant, how many cigarettes or packs of

cigarettes did you smoke on an average day?

Distribution of Mothers by Smoking Status During the Three Month Period Before Pregnancy Began

20.7

16.5

11.0

5.4

20.1

26.5

37.8

13.4 13.0 11.713.6

32.728.8

9.8

05

1015

2025

3035

40

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Smoked During the Three Month Period Before Pregnancy Began



Smoked18.9%

Did not smoke81.1%

36

SMOKING DURING PREGNANCYQuestion 40: In the last three months of your pregnancy, how many cigarettes or packs of

cigarettes did you smoke on an average day?

Distribution of Mothers by Smoking Status During the Last Three Months of Pregnancy

10.39.0 10.0

11.7

17.8

5.57.7 6.8

10.2

25.7

15.8

2.7

0

5

10

15

20

25

30

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Smoked During the Last Three Months of Pregnancy


Smoked9.4%

Did not smoke90.6%


37

SMOKING AFTER PREGNANCYQuestion 41: How many cigarettes or packs of cigarettes do you smoke on an average day now?

Distribution of Mothers by Smoking Status in the Postpartum Period

15.1 15.3

5.7 4.3

15.4

22.2

27.8

9.4 10.3 10.5 10.2

35.4

22.4

5.2

05

1015

2025

3035

40

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Smoked14.6%

Did not smoke85.4%

Percentage of Mothers Who Reported They Smoked in the Postpartum Period



38

ALCOHOL USE AND PRENATAL CAREQuestion 27: At any time during your prenatal care, did a doctor, nurse, or other health care

worker ask if you were drinking alcoholic beverages (beer, wine, wine cooler or liquor)?

Distribution of Mothers by Report of Having Been Asked About Alcohol Use During Prenatal Care

25.9

17.1 18.8

5.5

24.6

13.3

23.922.1

24.3 25.729.2

16.6

24.7

39.1

05

1015202530354045

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Were Not Asked About Alcohol Use During Prenatal Care



Not asked23.0%

Asked77.0%

39

ALCOHOL USE BEFORE PREGNANCYQuestion 43a: During the 3 months before you got pregnant, how many alcoholic drinks did you

have in an average week?

Distribution of Mothers by the Number of Alcoholic Drinks During the Three Month Period Preceding Pregnancy

58.1

40.6

31.6

19.4

54.4

34.1

50.0 52.355.0 55.8

52.9

25.6

50.7

59.6

0

10

20

30

40

50

60

70

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Any Alcohol Use in the Three Months Preceding Pregnancy



1-3 per week14.9%

4-6 per week3.1%

7 or more per week1.8%

<1 per week31.6%

None48.5%

40

ALCOHOL USE DURING PREGNANCYQuestion 44a: During the last 3 months of your pregnancy, how many alcoholic drinks did you

have in an average week?

Distribution of Mothers by the Number of Alcoholic Drinks During the Last Three Months of Pregnancy

9.6

4.0

11.0

8.5

3.6

7.5

4.3

10.4

12.3

16.9

2.94.6

11.7

02468

1012141618

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Any Alcohol Use in the Last Three Months of Pregnancy


None91.9%

<1 drink per week6.5%

1 or more drinks per week

1.6%


41

ALCOHOL BINGES BEFORE PREGNANCYQuestion 43b: During the 3 months before your got pregnant, how many times did you drink 5

alcoholic drinks or more in one sitting?

Distribution of Mothers by the Number of Alcohol Binges (5+ Drinks in One Sitting) During the Three Month Period

Preceding Pregnancy

15.7

8.6 8.7

11.713.4

9.9

21.2

10.1

14.0

10.28.5

10.8

18.8

11.1

0

5

10

15

20

25

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Any Binge Drinking in the Three Months Preceding Pregnancy



Two or more7.4%

One5.8%None

86.8%

42

ALCOHOL BINGES DURING PREGNANCYQuestion 44b: During the last 3 months of your pregnancy, how many times did you drink 5 alcoholic

drinks or more in one sitting?

Distribution of Mothers by the Number of Alcohol Binges (5+ Drinks in One Sitting) During the Last Three Months of

Pregnancy

0.7 0.3 0.3 1.3

0

5

10

15

20

25

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Any Binge Drinking During the Last Three Months of Pregnancy


One or more binges0.6%

No binges99.4%


43

PHYSICAL ABUSE BEFORE PREGNANCYQuestion 46a: During the 12 months before you got pregnant, did your husband or partner push, hit, slap,

kick, choke, or physically hurt you in any other way?

Distribution of Mothers by Abuse Before Pregnancy by Husband or Partner

4.4

6.1

4.8 4.9

10.1

7.7

6.2

1.52.5

6.0

3.5

0

2

4

6

8

10

12

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Abuse4.9%

No abuse95.1%

Percentage of Mothers Who Reported Having Been Physically Abused Before Pregnancy by Their Husband or Partner



44

PHYSICAL ABUSE BEFORE PREGNANCYQuestion 46b: During the 12 months before you got pregnant, did anyone else push, hit, slap, kick,

choke, or physically hurt you in any other way?

Distribution of Mothers by Abuse Before Pregnancy by Non-Partner

1.8

3.2

2.0 2.1

8.8

1.61.1 1.3 1.0

0123456789

10

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Abuse2.1%

No abuse97.9%

Percentage of Mothers Who Reported Having Been Physically Abused Before Pregnancy by Non-Partner



45

PHYSICAL ABUSE DURING PREGNANCYQuestion 47a: During your most recent pregnancy, did your husband or partner push, hit, slap, kick,

choke, or physically hurt you in any other way?

Distribution of Mothers by Abuse During Pregnancy by Husband or Partner

2.9

6.7

4.2 4.0

6.96.4 6.4

1.4 1.2

4.8

3.1

0

12

3

4

56

7

8

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Abuse4.1%

No abuse95.9%

Percentage of Mothers Who Reported Having Been Physically Abused During Pregnancy by Their Husband or Partner



46

PHYSICAL ABUSE DURING PREGNANCYQuestion 47b: During your most recent pregnancy, did anyone else push, hit, slap, kick, choke, or

physically hurt you in any other way?

Distribution of Mothers by Abuse by Non-Partner During Pregnancy

1.72.3

1.8 1.8

5.0

1.9

1.2

2.3

0.6

0

1

2

3

4

5

6

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Abuse1.8%

No abuse98.2%

Percentage of Mothers Who Reported Having Been Physically Abused Before Pregnancy by Non-Partner



47

SEAT BELT USE DURING PREGNANCYQuestion 83: During the last three months of your most recent pregnancy, how often did you wear a seat

belt when you drove or rode in a car?

Distribution of Mothers by Seat Belt Use During the Last Three Months of Pregnancy

8.17.2

16.4

6.5

12.111.3

6.1 6.24.5

16.2

11.8

2.4

02468

1012141618

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Did Not Always or Almost Always Wear a Seat Belt During the

Last Three Months of Pregnancy


Almost always7.3%

Sometimes3.6%

Rarely2.0%

Never1.7%

Always85.4%


48

POSTPARTUM SEAT BELT USEQuestion 84: Since you delivered your new baby, how often do you wear a seat belt when you drive or

ride in a car?

Distribution of Mothers by Postpartum Seat Belt Use

5.6 5.9

11.8

4.8

11.1

8.4

3.64.4

3.1

9.9

1.5

0

2

4

6

8

10

12

14

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported They Did Not Always or Almost Always Wear a Seat Belt in the Postpartum Period


Almost always8.5%

Sometimes3.4%

Rarely1.0%

Never0.9%

Always86.2%


49

Postpartum Factors:Maternal and Infant Health

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“I know many new parents who are stressed out about ababy’s crying, etc., and don’t know where to turn for help.I think there should be a new parent support group”

“After my baby was born, the full weight of the depressionset in.”

“Having a baby was the greatest thing that ever happenedto me.”

“I think more mothers would breastfeed if better informed.”

“I was fortunate to have had my first child in Europe. . .and was visited daily for 10 days after being released fromthe hospital and weekly for the first six months. Because ofthese visits, I stuck with breastfeeding and my postnataldepression was diagnosed and treated quickly.”

PRAMS mothers

5 2

POSTPARTUM BIRTH CONTROLQuestion 72: Are you or your husband or partner doing anything now to keep from getting pregnant?

Distribution of Mothers by Use of Postpartum Birth Control

15.718.4

25.9

22.5

16.818.6

11.9

20.1

13.1

24.426.5

23.9

15.116.6

0

5

10

15

20

25

30

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported No Use of Postpartum Birth Control



Not using birth control17.2%

Using birth control82.8%

53

REASONS FOR NO POSTPARTUM BIRTH CONTROLQuestion 73: What are your or your husband’s or partner’s reasons for not doing anything to keep from

getting pregnant now?

Reasons Reported for Not Using Postpartum Birth Control

5.7

6.2

7.6

10.8

14.6

23.6

37.0

0 10 20 30 40

Pregnant

Infertile

Can't afford

Want to get pregnant

Husband or partner doesn't want to

Don't want to

Not having sex

Percent

54

POSTPARTUM DEPRESSIONQuestion 75: In the months after your delivery, would you say that you were not depressed at all, a little

depressed, moderately depressed, very depressed, or very depressed and had to get help?

Distribution of Mothers by Level of Postpartum Depression

18.5

23.3

18.0

6.2

21.024.2

20.1 20.517.1

18.8

32.7

19.8

23.5

16.8

0

5

10

15

20

25

30

35

White

Black

Other

Hispanic

Non-Hisp

anic <2020-24

25-2930-34

35-3940+

<12 12>12

Perc

ent

Percentage of Mothers Who Reported Being at Least Moderately Depressed



Slightly depressed

38.6%Moderately depressed

11.0%

Very depressed7.0%

Needed help1.9%Not depressed

41.6%

55

NEONATAL INTENSIVE CAREQuestion 52: After your baby was born, was he or she put in an intensive care unit?

Distribution of Infants by Admission to a Neonatal Intensive Care Unit

10.4

18.2 18.5

13.3 13.011.3

8.8

13.9 14.115.7

14.4

20.4

12.5 12.3

0

5

10

15

20

25

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Their Newborn was Admitted to the Neonatal Intensive Care Unit



Intensive care13.0%

No intensive care87.0%

56

LENGTH OF HOSPITAL STAY--NEWBORNQuestion 53: After your baby was born, how long did he or she stay in the hospital?

Distribution of Infants by Length of Hospital Stay

6.5

11.3

4.4

7.5 7.8 7.46.1

8.0 8.67.5

10.8

15.1

7.2 6.8

0

24

6

8

1012

14

16

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported that Newborn Stayed in the Hospital for Six or More Days



3-5 days32.7%

6 days or more7.7%

Not born in hospital

0.2%1-2 days59.4%

57

BREASTFEEDING INITIATIONQuestion 59: Did you ever breastfeed or pump breast milk to feed your new baby after delivery?

Distribution of Mothers by Breastfeeding Status

78.9

67.0

90.4 89.7

75.3

58.4

74.6 78.7 79.6 79.885.3

62.8 64.1

89.1

0102030405060708090

100

White

Black

Other

Hispanic

Non-Hisp

anic <2020-24

25-2930-34

35-3940+

<12 12>12

Perc

ent

Did not breastfeed

23.5%Breastfed

76.5%

Percentage of Mothers Who Reported Ever Breastfeeding Their Infant



58

BREASTFEEDINGQuestion 61: How many weeks or months did you breastfeed or pump milk to feed your baby?

Distribution of Mothers by Length of Time Infant Was Breastfed

66.1

55.2

72.3

85.2

61.7

39.7

57.6

67.4 67.172.0

76.4

44.751.0

78.4

0102030405060708090

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

Percentage of Mothers Who Reported Breastfeeding for Four or More Weeks



<4 weeks12.5%

4-7 weeks8.5%

8+ weeks55.1%

Never23.9%

59

SLEEP POSITIONQuestion 64: How do you most often lay your baby down to sleep now?

Distribution of Infants by Sleep Position

13.6

24.2

17.0

8.3

17.4

25.1

19.7

10.7

15.717.9

19.4

8.3

17.915.7

0

5

10

15

20

25

30

White

Black

Other

Hispanic

Non-Hisp

anic <2020-24

25-2930-34

35-3940+

<12 12>12

Perc

ent

Back61.4%

Stomach16.6%

Combination3.6%

Side18.4%

Percentage of Infants Usually Placed on Stomach to Sleep



60

INFANT HEALTH CARE VISITQuestion 67: Was your baby seen by a doctor, nurse, or other health care provider in the first week after

he or she left the hospital?

Distribution of Births by Health Care Visit in the First Week After Leaving the Hospital

15.216.5

27.4

15.9 16.1

26.5

8.6

17.2 16.5 17.214.8

13.6

18.0

13.3

0

5

10

15

20

25

30

White

BlackOther

Hispanic

Non-H

ispanic <20

20-24

25-29

30-34

35-39 40+ <12 12

>12

Perc

ent

No16.1%

Yes83.9%

Percentage of Mothers Who Reported Their Baby Did Not Have a Health Care Visit in the First Week After Leaving the Hospital



61

Maryland PRAMS Phase 4 Questionnaire

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“ Doctors and nurses should ask the questions you guys ask on the survey.”

“The questionnaire was very insightful for mothers like me. Thanx for including me in the survey.”

“Thank you for taking an interest in health care of mothers and babies.”

PRAMS mothers

6 4

First, we would like to ask a few questions about you and the time before you got pregnant with your new baby. Please check the box next to your answer.

1 Just before you got pregnant, did you have health insurance? (Do not count Medicaid [including Healthchoice].)

No Yes

2 Just before you got pregnant, were you on Medicaid (including HealthChoice)?

No Yes

3 In the month before you got pregnant with your new baby, how many times a week did you take a mul-tivitamin (a pill that contains many different vitamins and minerals)?

I did not take a multivitamin at all 1 to 3 times a week 4 to 6 times a week Every day of the week

4 What is your date of birth?

Month Day Year

5 Just before you got pregnant, how much did you weigh?

Pounds OR Kilos

6 How tall are you without shoes?

Feet Inches OR Centimeters

7 Before your new baby, did you ever have any other babies who were born alive?

No → Go to Question 11 Yes

Kilos Pounds

Feet Inches Feet Inches Centimeters

65

8 Did the baby born just before your new one weigh 5 pounds, 8 ounces (2.5 kilos) or less at birth?

No Yes

9 Was the baby just before your new one born more than 3 weeks before its due date?

No Yes

10 How old were you when you got pregnant with your fi rst baby?

Years old

11 How old were you when you had your fi rst menstrual period?

Years old

The next questions are about just before you became pregnant with your new baby.

12 Thinking back to just before you got pregnant, how did you feel about becoming pregnant? Check one answer.

I wanted to be pregnant sooner I wanted to be pregnant sooner I wanted to be pregnant later I wanted to be pregnant later I wanted to be pregnant then I wanted to be pregnant then I didn’t want to be pregnant then or at any time in the future

13 When you got pregnant with your new baby were you trying to become pregnant?

No Yes → Go to Question 16

14 When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant? (Some things people do to keep from getting pregnant include not having sex at certain times [rhythm], and using birth control methods such as the pill, Norplant®, shots [Depo-Provera®], condoms, diaphragm, foam, IUD, having their tubes tied, or their partner having a vasectomy.)


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15 What were you or your husband or partner’s reasons for not doing anything to keep from getting preg-nant? Check all that apply, then go to Question 18.

I didn’t mind if I got pregnant I didn’t mind if I got pregnant I thought I could not get pregnant at that time I thought I could not get pregnant at that time I had side effects from the birth control method I was using I had side effects from the birth control method I was using I had problems getting birth control when I needed it I had problems getting birth control when I needed it I thought my partner or I was sterile (could not get pregnant at all) I thought my partner or I was sterile (could not get pregnant at all) My husband or partner did not want to use anything My husband or partner did not want to use anything Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

16 Did you take any fertility drugs to help you get pregnant with your new baby? (Fertility drugs include Clomid®, Serophene®, Pergonal® or any other drugs which you may have taken to help you get preg-nant.)

No Yes

17 Did you use any medical procedures (assisted reproductive technology) to help you get pregnant with your new baby? (Assisted reproductive technology procedures include in vitro fertilization [IVF], GIFT, ZIFT, embryo transfer, and donor oocytes.)

No Yes

The next questions are about the prenatal care you received during your most recent pregnancy. Prenatal care includes visits to a doctor, nurse, or other health care worker before your baby was born to get checkups and advice about pregnancy. (It may help to look at a calendar when you answer these questions.)

18 How many weeks or months pregnant were you when you were sure you were pregnant? (For example, you had a pregnancy test or a doctor or nurse said you were pregnant.)

Weeks OR Months I don’t remember

19 How many weeks or months pregnant were you when you had your fi rst visit for prenatal care? (Don’t count a visit that was only for a pregnancy test or only for WIC [the Special Supplemental Nutri-tion Program for Women, Infants, and Children].)

Weeks OR Months I didn’t go for prenatal care

questions.)

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20 Did you get prenatal care as early in your pregnancy as you wanted?

No Yes → Go to Question 22 I did not want prenatal care → Go to Question 22

21 Did any of these things keep you from getting prenatal care as early as you wanted? Check all that apply.

I couldn’t get an appointment earlier in my pregnancy I couldn’t get an appointment earlier in my pregnancy I didn’t have enough money or insurance to pay for my visits I didn’t have enough money or insurance to pay for my visits I didn’t know that I was pregnant I didn’t know that I was pregnant I had no way to get to the clinic or doctor’s offi ce I had no way to get to the clinic or doctor’s offi ce The doctor or my health plan would not start care earlier The doctor or my health plan would not start care earlier I didn’t have my Medicaid card I didn’t have my Medicaid card I had no one to take care of my children I had no one to take care of my children I had too many other things going on I had too many other things going on Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

If you did not go for prenatal care, go to Question 28.

22 Where did you go most of the time for your prenatal visits? (Do not include visits for WIC.) Check one answer.

Hospital clinic Hospital clinic Health department clinic Health department clinic Private doctor’s offi ce or HMO clinic Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

23 How was your prenatal care paid for? Check all that apply.

Medicaid (including HealthChoice) Medicaid (including HealthChoice) Personal income (cash, check, or credit card) Health insurance or HMO Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

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24 During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? (Please count only discussions, not reading materials or vid-eos.) For each item, circle Y (Yes) if someone talked with you about it or circle N (No) if no one talked with you about it. No Yesa. How smoking during pregnancy could affect your baby N Yb. Breastfeeding your baby N Yc. How drinking alcohol during pregnancy could affect your baby N Yd. Using a seat belt during your pregnancy N Ye. Birth control methods to use after your pregnancy N Yf. Medicines that are safe to take during your pregnancy N Yg. How using illegal drugs could affect your baby N Yh. Doing tests to screen for birth defects or diseases that run in your family N Yi. What to do if your labor starts early N Yj. Getting your blood tested for HIV(the virus that causes AIDS) N Yk. Physical abuse to women by their husbands or partners N Y

25 We would like to know how you felt about the prenatal care you got during your most recent preg-nancy. If you went to more than one place for prenatal care, answer for the place where you got most of your care. For each item, circle Y (Yes) if you were satisfi ed or N (No) if you were not satisfi ed.

Were you satisfi ed with... No Yes

a. The amount of time you had to wait after you arrived for your visits N Yb. The amount of time the doctor or nurse spent with you during your visits N Yc. The advice you got on how to take care of yourself N Yd. The understanding and respect that the staff showed toward you as a person N Y

26 At any time during your prenatal care, did a doctor, nurse, or other health care worker ask if you were smoking cigarettes?

No Yes

27 At any time during your prenatal care, did a doctor, nurse, or other health care worker ask if you were drinking alcoholic beverages (beer, wine, wine cooler, or liquor)?

No Yes

28 Have you ever heard or read that taking the vitamin folic acid can help prevent some birth defects?

No Yes

The next questions are about your most recent pregnancy and things that might have happened during

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your pregnancy.

29 During your pregnancy, were you on WIC (the Special Supplemental Nutrition Program for Women, Infants and Children)?

No Yes

30 Did you have any of these problems during your pregnancy? For each item, circle Y (yes) if you had the problem and N (No) if you did not.

No Yesa. Labor pains more than 3 weeks before your baby was due (preterm or early labor) N Yb. High blood pressure (including pre-eclampsia or toxemia) or retained water (edema) N Yc. Vaginal bleeding N Yd. Problems with the placenta (such as abruptio placental, placenta previa) N Ye. Severe nausea, vomiting or dehydration N Yf. High blood sugar (diabetes) N Yg. Kidney or bladder (urinary tract) infection N Yh. Water broke more than 3 weeks before your baby was due (premature rupture of membranes, PROM) N Yi. Cervix had to be sewn shut (incompetent cervix, cerclage) N Yj. You were injured in a car accident N Y

If you did not have any of these problems, go to Question 36.

31 Did you do any of the following things because of these problem(s)? Check all that apply.

I went to the hospital or emergency room and stayed less than 1 day I went to the hospital or emergency room and stayed less than 1 day I went to the hospital and stayed 1-7 days I went to the hospital and stayed 1-7 days I went to the hospital and stayed more than 7 days I went to the hospital and stayed more than 7 days I stayed in bed at home more than 2 days because of my doctor or nurse’s advice

32 At any time during your most recent pregnancy, were you told to stay in bed for at least one week?

No → Go to Question 36 Go to Question 36 Go to Question 36 Yes

33 How many weeks or months pregnant were you when you were told to stay in bed?

Weeks OR Months

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34 How often were you able to follow your provider’s instruction to stay in bed?

Always → Go to Question 36 Always Almost always → Go to Question 36 Almost always Sometimes Rarely Rarely Never

35 What types of support would have helped you to stay in bed for the recommended time? Check all that apply.

Help with child care Help with child care Help with housework Help with housework Knowing I wouldn’t lose my job Knowing I wouldn’t lose my job Money to make up for not working Money to make up for not working Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

36 Have you ever had German measles (rubella) or been vaccinated for German measles?

No Yes

37 Have you ever had chickenpox (varicella) or been vaccinated for chickenpox?

No Yes

The next questions are about smoking cigarettes and drinking alcohol.

38 Have you smoked at least 100 cigarettes in the past 2 years? (A pack has 20 cigarettes)


39 In the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day? (A pack has 20 cigarettes)

Cigarettes OR Packs Less than 1 cigarette a day Less than 1 cigarette a day I didn’t smoke I don’t know

The next questions are about smoking cigarettes and drinking alcohol.

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40 In the last 3 months of your pregnancy, how may cigarettes or packs of cigarettes did you smoke on an average day?

Cigarettes OR Packs Less than 1 cigarette a day Less than 1 cigarette a day I didn’t smoke I don’t know

41 How many cigarettes or packs of cigarettes do you smoke on an average day now?

Cigarettes OR Packs Less than 1 cigarette a day Less than 1 cigarette a day I don’t smoke I don’t know

42 Have you had any alcoholic drinks in the past 2 years? (A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink.)

No → Go to Page 73, Question 45 Yes

43a During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week?

I didn’t drink then Less than 1 drink a week 1 to 3 drinks a week 4 to 6 drinks a week 7 to 13 drinks a week 14 drinks or more a week I don’t know

43b During the 3 months before you got pregnant, how many times did you drink 5 or more alcoholic drinks in one sitting?

Times I didn’t drink then I don’t know

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44a During the last 3 months of your pregnancy, how many alcoholic drinks did you have in an average week?

I didn’t drink then Less than 1 drink a week 1 to 3 drinks a week 4 to 6 drinks a week 7 to 13 drinks a week 14 drinks or more a week I don’t know

44b During the last 3 months of your pregnancy, how many times did you drink 5 or more alcoholic drinks in one sitting?

Times

I didn’t drink then I don’t know

Pregnancy can be a diffi cult time for some women. These next questions are about things that may have happened before and during your most recent pregnancy.

45 This question is about things that may have happened during the 12 months before your new baby was born. For each item, circle Y (Yes) if it happened to you or N (No) if it did not. (It may help to use the calendar.)

No Yesa. A close family member was very sick and had to go into the hospital N Yb. You got separated or divorced from your husband or partner N Yc. You moved to a new address N Yd. You were homeless N Ye. Your husband or partner lost his job N Yf. You lost your job even though you wanted to go on working N Yg. You argued with your husband or partner more than usual N Yh. Your husband or partner said he did not want you to be pregnant N Yi. You had a lot of bills you could not pay N Yj. You were in a physical fi ght N Yk. You or your husband or partner went to jail N Yl. Someone very close to you had a bad problem with drinking or drugs N Ym. Someone very close to you died N Y

46a During the 12 months before you got pregnant, did your husband or partner push, hit, slap, kick, choke, or physically hurt you in any other way?

No Yes

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46b During the 12 months before you got pregnant, did anyone else physically hurt you in any way?

No Yes

47a During your most recent pregnancy, did your husband or partner physically hurt you in any way?

No Yes

47b During your most recent pregnancy, did anyone else physically hurt you in any way?

No Yes

The next questions are about your labor and delivery. (It may help to look at the calendar when you an-swer these questions.)

48 When was your baby due?

Month Day Year

49 When did you go to the hospital to have your baby?

Month Day Year Month Day Year I did not have my baby in a hospital

50 When was your baby born?

Month Day Year

51 When were you discharged from the hospital after your baby was born? (It may help to use the calendar.)

Month Day Year Month Day Year I did not have my baby in a hospital

52 After your baby was born, was he or she put in an intensive care unit? After your baby was born, was he or she put in an intensive care unit? No Yes I don’t know

Month Day Year Month Day Year Month Day Year




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53 After your baby was born, how long did he or she stay in the hospital?

Less than 24 hours (Less than 1day) Less than 24 hours (Less than 1day) 24 - 48 hours (1-2 days) 24 - 48 hours (1-2 days) 3 days 3 days 4 days 4 days 5 days 5 days 6 or more days 6 or more days My baby was not born in a hospital My baby was not born in a hospital My baby did not stay overnight in the hospital My baby did not stay overnight in the hospital My baby is still in the hospital

54 How was your delivery paid for? Check all that apply.

Medicaid (including HealthChoice) Medicaid (including HealthChoice) Personal income (cash, check or credit card) Health insurance or HMO Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

55 What is today’s date?

Month Day Year

56 Is your baby alive now?


57 When did your baby die?

Month Day Year

Go to Page 78, Question 72

The next questions are about the time since your new baby was born. The next questions are about the time since your new baby was born.

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58 Is your baby living with you now?


59 Did you ever breastfeed or pump breast milk to feed your new baby after delivery?


60 Are you still breastfeeding or feeding pumped milk to your new baby?


61 How many weeks or months did you breastfeed or pump milk to feed your new baby?

Weeks OR Months Less than 1 week

62 How old was your baby the fi rst time you fed him or her anything besides breast milk? Include for-mula, baby food, juice, cow’s milk, water, sugar water, or anything else you fed your baby.

Weeks OR Months

My baby was less than one week old My baby was less than one week old I have not fed my baby anything besides breast milk

If your baby is still in the hospital, go to page 78, Question 72.

63 About how many hours a day, on average, is your new baby in the same room with someone who is smoking?

Hours Less than one hour a day Less than one hour a day My baby is never in the same room with someone who is smoking

64 How do you most often lay your baby down to sleep now? Check one answer.

On his or her side On his or her back On his or her stomach

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65 Is your new baby a boy or a girl?

Boy Boy Girl → Go to Question 67

66 Did you have your new baby boy circumcised?

No Yes

67 Was your baby seen by a doctor, nurse or other health care provider in the fi rst week after he or she left the hospital?

No → Go to Question 67 Go to Question 67 Go to Question 67 Yes

68 Was your baby seen at home or at a health care facility?

At home At a doctor’s offi ce, clinic, or other health care facility

69 Has your baby had a well-baby checkup?


70 How many times has your baby been to a doctor or nurse for a well-baby checkup? (It may help to use the calendar.)

Times

71 Where do you usually take your baby for well-baby checkups? Check one answer.

Hospital clinic Hospital clinic Health department clinic Health department clinic Private doctor’s offi ce or HMO clinic Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

77

72 Are you or your husband or partner doing anything now to keep from getting pregnant? (Some things people do to keep from getting pregnant include having their tubes tied or their partner having a va-sectomy, using birth control methods like the pill, Norplant®, shots [Depo-Provera®] condoms, dia-phragm, foam, IUD, and not having sex at certain times [rhythm].)


73 What are you or your husband or partner’s reasons for not doing anything to keep from getting preg-nant now? Check all that apply.

I am not having sex I am not having sex I want to get pregnant I want to get pregnant I don’t want to use birth control My husband or partner doesn’t want to use anything My husband or partner doesn’t want to use anything I don’t think I can get pregnant (sterile) I don’t think I can get pregnant (sterile) I can’t pay for birth control I can’t pay for birth control I am pregnant now I am pregnant now Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

74 After your new baby was born, did a doctor, nurse, or other health care worker with you about using birth control?

No Yes

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75 In the months after your delivery, would you say that you were. . . (Check one answer.)

Not depressed at all Not depressed at all A little depressed A little depressed Moderately depressed Moderately depressed Very depressed Very depressed Very depressed and had to get help

The next questions are about your family and the place where you live.

76 Which rooms are in the house, apartment, or trailer where you live? Check all that apply.

Living room Living room Separate dining room Separate dining room Kitchen Bathroom(s) Recreation room, den or family room Recreation room, den or family room Finished basement Bedrooms -- How many?

77 Counting yourself, how many people live in your house, apartment, or trailer?

Adults (people aged 18 years or older) Adults (people aged 18 years or older) Babies, children, or teens (people aged 17 years or younger)

78 What were the sources of your household’s income during the past 12 months? Check all that apply.

Paycheck or money from a job Paycheck or money from a job Aid such as Temporary Assistance for Needy Families (TANF) or Temporary Cash Assistance

(TCA), welfare, public assistance, general assistance, food stamps or Supplemental Security Income(TCA), welfare, public assistance, general assistance, food stamps or Supplemental Security Income Unemployment benefi ts Unemployment benefi ts Child support or alimony Child support or alimony Social Security, worker’s compensation, veterans benefi ts, or pensions Social Security, worker’s compensation, veterans benefi ts, or pensions Money from a business, fees, dividends or rental income Money from a business, fees, dividends or rental income Money from family or friends Money from family or friends Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

79

79 Between the time you became pregnant and now, have you applied for TCA (Temporary Cash Assistance)?


80 Did you get TCA?


81 Why didn’t you get TCA? Check all that apply.

You were ineligible because of your income You were ineligible because of your income You had reached your time limit You had reached your time limit You had to fulfi ll work or other requirements You had to fulfi ll work or other requirements You had to return on another day to apply You had to return on another day to apply You had previously lost TCA for another reason (administrative reasons, sanctions, etc) You had previously lost TCA for another reason (administrative reasons, sanctions, etc) You are not a U.S. citizen Other -- Please tell us: ____________________________________________________________________

_______________________________________________________________________________________________ ___________________________________________________________________________________________________________

82 This question is about the care of your teeth during your most recent pregnancy. For each thing, circle Y (Yes) if it is true or N (No) if it is not true.

No Yesa. I needed to see a dentist for a problem N Y

b. I went to a dentist or dental clinic N Yc. A dental or other health care worker talked with me

about how to care for my teeth and gums N Y

83 During the last three months of your most recent pregnancy, how often did you wear a seat belt when you drove or rode in a car? Check one answer.

Always Always Almost always Almost always Sometimes Rarely Rarely Never

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84 Since you delivered your new baby, how often do you wear a seat belt when you drive or ride in a car? Check one answer.

Always Always Almost always Almost always Sometimes Rarely Rarely Never

85 In the twelve months before your delivery, what was your total household income? (Include income from all sources, before taxes.)

Under $8,000 $8,000 - $11,999 $12,000 - $15,999 $16,000 - $19,999 $20,000 - $24,999 $25,000 - $29,999 $30,000 - $39,999 $40,000 or more

86 How many people, including yourself, depended on this income?

People

Please use this space for any additional comments you would like to make about the health of mothers and babies in Maryland.

_______________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

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The services and facilities of the Maryland Department of Health and Mental Hygiene (DHMH) are operated on a non-discriminatory basis. This policy prohibits discrimination on the basis of race, color, sex, or national origin and applies to the provisions of employment and granting of advantages, privileges, and accommodations. The Department, in compliance with the Americans With Disabilities Act, ensures that qualified individuals with disabilities are given an opportunity to participate in and benefit from DHMH services, programs, benefits, and employment opportunities.

Funding for this publication was provided by the Maryland Department of Health and Mental Hygieneand by grant #U50/CCU317134-04 from the Centers for Disease Control and Prevention, Pregnancy Risk Assessment Monitoring System (PRAMS)

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